Infection with Human Immunodeficiency Virus is widespread in Malawi and cryptococcal meningitis is a common problem in those with AIDS. A review of microbiology laboratory records in Lilongwe and Blantyre between July 1991 and January 1993 identified 31 patients with cryptococcal meningitis. Diagnosis was based on a positive India ink stain of CSF and/or culture of Cryptococcus neoformans. There were 16 men (median age 38 years) and 15 women (median age 28 years) in the investigation. The median duration of symptoms was 2 weeks. The clinical presentation was varied, the most frequent features being headache (97%), neck stiffness (74%), fever (61%) and altered consciousness (58%). CSF WBC count, glucose and protein concentrations were non-specific. Most patients could not afford anti-cryptococcal chemotherapy and their median survival time after diagnosis was 4 days. Patients who could afford such treatment survived for up to several months. Diagnosis is useful for prognostic reasons and may save patients unnecessary treatment if tuberculous meningitis is the alternative diagnosis. Cryptococcal antigen detection tests may improve diagnostic accuracy. The problem of cryptococcal meningitis is likely to become increasingly common as HIV infection becomes more widespread.
PIP: In Malawi, a physician from Queen Elizabeth Central Hospital in Blantyre and one from Kamuzu Central Hospital in Lilongwe retrospectively analyzed laboratory records to determine the clinical features, cerebrospinal fluid (CSF) findings, treatment, and outcome of 31 patients with cryptococcal meningitis admitted to the hospitals between July, 1991, and January, 1993. Cryptococcal meningitis is a common manifestation of cryptococcosis in people with AIDS. It has become prevalent in Malawi in the last 5 years. The incidence of cryptococcal meningitis cases among medical admissions at both hospitals was 0.1%/year. The median ages of the 16 men and 15 women were 38 and 28 years, respectively. Symptoms lasted from 1 day to 5 months (median, 2 weeks). The leading signs and symptoms included headache (97%), neck stiffness (74%), fever (61%), altered consciousness (58%). The records revealed nonspecific readings for CSF white blood cell count and glucose and protein concentrations. 81% of the cases did not receive antifungal chemotherapy because they could not afford it. None of these untreated patients survived longer than 30 days after diagnosis of cryptococcal meningitis. Most died within the 1st 4 days. In fact, the median survival time after diagnosis for all 31 patients was 4 days. The patients who could afford antifungal chemotherapy survived 4 to at least 9 months. Diagnosis helps clinicians to make more accurate prognoses and keeps them from prescribing unnecessary treatment, especially if tuberculosis meningitis is the other diagnosis. As the prevalence of AIDS increase in Malawi, so should cryptococcal meningitis.